Contrary to the popular coaching edict, some of the thousands of Iowa children who will take to the field this month for another spring soccer season will have to keep their heads out of the game.

The Iowa Soccer Association, in accordance with new player safety recommendations from U.S. Soccer, in March notified members that it’s banning heading for all players under age 11. The prohibition — aimed at cutting the risk for concussions and head injuries — extends to all under-4 through under-10 Iowa Soccer Association programming, including games, practices and tournaments.

Players who intentionally head the ball during a game will be penalized with an indirect free kick for the other team — those are free kicks that require another player to touch the ball before it can go into the net and count as a goal.

Andrew Peterson, a clinical associate professor with University of Iowa Sports Medicine, conducts concussion-related research with the UI Concussion Clinic and works with UI wrestlers and football players to prevent and treat head injuries. He said the science of concussions is developing, and researchers believe people who get hit in the head for a living are most at risk of long-term brain damage and disease.

But, Peterson said, they also have “clear evidence that people who play contact sports as a young person are more at risk of having changes in their brain.” Thus, changing the header rules for America’s youngest soccer players seems a reasonable step, he said.

“U10 soccer should be played mostly on the ground anyway,” Peterson said. “So if they are able to get rid of headers and improve the ground play, it should not be a detriment to the game.”

The U.S. Soccer youth heading recommendations grew out of its 2015 concussion initiative, which incorporated advice from “recognized experts in the field of concussions and concussion management.”

The initiative’s recommendations, which were to be implemented starting in January, also included limiting the amount of heading in practice for 11- to 13-year-olds and modifying game substitution rules to let players who might have suffered a concussion be evaluated without penalty.

Although U.S. Soccer suggested the changes as recommendations, youth organizations in many states — including Iowa — are making them mandatory. The Iowa Soccer Association, in communicating its new rules, specified that only deliberate headers among players under the ban will be penalized, and referees can decide whether someone intentionally headed the ball or not.

The Iowa association also specified limits on 11-13 heading in practice to no more than 15 to 20 headers a week. The U.S. Soccer advice includes the caveat that head injury-related science is developing and its recommendations allow for flexibility as researchers learn more.

Peterson said that makes sense, as he believes much of the soccer-related concussion concerns relate not necessarily to hitting the ball with the head but to head-on-head collisions that occur when two players compete for a ball.

“It’s the events around the heading,” Peterson said.

‘In 10 to 15 years we will know a lot more’

Recent research links concussions and chronic traumatic encephalopathy, or CTE, which is a degenerative brain disease associated with memory and mood problems. But, Peterson said, knowledge around concussions remains in its infancy.

“We don’t think that having a handful of concussions as a young person is particularly dangerous.”

The research is ongoing, however, including at the University of Iowa, where Peterson said his lab is focused on concussion diagnoses, which right now largely rely on patient symptoms. Some of the UI research is specific to young football players, while another study is analyzing emergency room visits.

All the findings hinge on how a person is feeling, and Peterson said scientists would love to develop another, more-functional test allowing concussion diagnoses through brain scans or blood tests.

“I suspect in 10 to 15 years we will know a lot more about concussions,” he said. “But right now we are relying on symptoms.”

That, in part, is why Peterson said he wouldn’t discourage children from playing sports out of fear they’ll suffer a head injury. Benefits athletics provide by way of exercise and team work — to name a few — far outweigh any risk at a young age, Peterson said.

“I’m never going to discourage normal health kids from playing sports of any kind,” he said. “Kids who are active tend to be active adults … and the risk of concussion is nothing compared to the risk of inactivity.”

But, he said, taking precautions to risk potential injury typically can’t hurt. And that extends beyond rule changes to good technique and simple education. Concussion-related prevention and awareness has spiked across the country in a variety of sports and at a variety of levels — from youth soccer to the National Football League.

The UI Concussion Clinic, which opened six years ago, has seen the results in fewer referrals for standard concussions, Peterson said.

“Because of those educational initiatives, lots of people have become comfortable with basic concussion management,” he said. “Now we are seeing more of the weird ones.”

‘We have to be concerned’

Jon Cook, director of coaching for the Iowa City-based Iowa Soccer Club program that serves about 550 children, said his team of trainers and coaches pay close attention to player safety. Because of that, Cook said, he doesn’t include heading in his training and rarely sees it in the under-10 play.

“I have never done a lot of heading because I’ve had the sense that it’s not the right thing to do for the developing brain,” he said.

Thus the rule changes won’t affect his club’s curriculum or even game play much — although he conceded it might create some awkward situations for players trying to avoid heading a ball when it would be the most natural move.

And Cook said he’s OK with the ban — especially as more research emerges related to concussion risks and long-term effects. But, he said, there is an alternate view among youth soccer coaches that dropping heading from the early training regimen will leave players inadequately prepared to use the skill properly once it is allowed in game play.

“There is a school of thought among some that it will only make it more difficult for the kids to be safe when they are older and actually allowed to head the ball,” he said, adding that he doesn’t subscribe to that belief.

“Untimely we have to be concerned about it because soccer has a high rate of incidents of concussions,” he said. “I’ve seen that first hand as a coach.”

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